Is this your (paediatric patient’s) brain on (anaesthetic) drugs?: The search for a potential neurological phenotype of anaesthesia-related neurotoxicity in humans

A popular advertising campaign in the 1980s and 1990s illustrated the dangers of drug and alcohol abuse for the teenage brain by showing a raw egg (‘This is your brain’) being cracked and fried in a pan (‘This is your brain on drugs’). In a sense, this was a simplified representation of the phenotype of drug use in the developing teenage brain. Researchers are trying to identify whether there exists a neurological phenotype following early childhood exposure to a class of therapeutic drugs, anaesthetics and sedatives. Concerns for potential harmful effects of anaesthetics on brain development in young children undergoing surgical procedures were first raised by animal studies demonstrating widespread cell death of neurones and oligodendrocytes, reductions in neurotrophic factors, alterations in synaptic and dendritic densities, disintegration of the cytoskeleton and long-term neurocognitive impairment following anaesthetic exposure early in life. .

It is still not clear whether there exists a specific neurological phenotype associated with exposure to surgery with general anaesthesia early in life. It would obviously represent a major threat to child health if animal studies demonstrating widespread neuronal elimination, brain structural abnormalities and neurocognitive deficits following anaesthetic exposure early in life applied directly to humans. Given the immense importance for individual wellbeing as well as societal health, intensified research efforts are needed to determine whether or not surgical procedures with general anaesthesia have any long-term effects on the developing human brain.